Ask the Coaches: Sacral Stress Fracture

Jan 1, 2003

Q: Dear Coaches:

I need some advice about restarting training after a sacral stress fracture. I am 40 years old and have been running for the past 3 years without any prior back problems or previous stress fractures. I realize (retrospectively) that the cause of the stress fracture was increasing mileage too quickly. I was having some difficulty with plantar fasciitis and then suffered a groin pull a few days after a Thanksgiving day 10K. The following 4 weeks I cut my mileage significantly (about 40-50 miles a week from a base of about 75-80 miles/week). I then started back at about 50 miles a week increasing to 60 miles the second week and 70 miles the third week as I was trying to get back on schedule to run the Boston Marathon in April. I then developed back pain and was unable to bear weight or walk for 2 days. An MRI showed no disc problems and I was suspected of having a sacral stress fracture. I have been going to physical therapy for 4 weeks and have been cleared to start running again!

During physical therapy I was allowed to do non-impact exercise and have been able to maintain some cardiovascular fitness using the elliptical machine and recumbant bike. I have no plans for any spring marathon or races and would like your advice regarding miles, speed work and rest days over the next few months so I don't get re-injured. Thanks. --Michael Weiss

A: I will typically hold a runner with a sacral stress fracture out of running for 6 to 8 weeks.During this time, non-impact training (pool running, etc.) and physical therapy to strengthen your back and hips is recommended.

The most common cause of stress fractures in an otherwise healthy population is over training. You have first hand experience with this.

I would recommend a very gradual return to running program, based on time, not mileage. Run every other day for 20 to 30 minutes at an easy pace. Supplement your running with non-impact cross training. After 2 weeks, run 2 days and then take a day off. You may increase your running time to 40 minutes twice a week. If you are not experiencing problems, in 2 weeks increase running frequency to 3 days before a day off (from running).After a week, increase the length of one run to 50 minutes. Each week, you may gradually increase your running time. Once you are running 4 hours per week, you can start to add in some speed work; do not increase intensity and distance (time) during the same week. It will take time to build your base, but patience will decrease your risk of injury.

A Part of Hearst Digital Media
Runner's World participates in various affiliate marketing programs, which means we may get paid commissions on editorially chosen products purchased through our links to retailer sites.